Employee Survival Guide® - S6 Ep124: Dr. Carrie Cunningham's Story: When Healers Need Healing

Episode Date: May 1, 2025

Comment on the Show by Sending Mark a Text Message.Beneath the sterile drapes and surgical masks lies a devastating truth: surgeons have the highest suicide rate among all physicians. A staggering 15% report having contemplated ending their lives at some point in their careers, with 6% having such thoughts within just a single year.The juxtaposition is jarring – these talented professionals represent the pinnacle of medical achievement, yet many battle profound personal demons in silence. Through Dr. Carrie Cunningham's courageous presidential address to the Association for Academic Surgery, we witness this paradox firsthand. Despite her Harvard professorship, research grants, and leadership positions, she openly shared her struggles with depression, anxiety, and substance use disorder. Her vulnerability challenges our assumptions that external success guarantees internal well-being.The factors driving this crisis run deep. Medical training itself plants the seeds, with studies showing one-third of interns develop clinical depression. The surgical culture's emphasis on perfectionism, combined with sleep deprivation and high-stakes decision-making, creates tremendous pressure. Add to this the startling revelation that 45% of physicians experienced serious trauma before even entering medicine, and we begin to understand the perfect storm threatening our healers.Most concerning is the pervasive fear preventing surgeons from seeking help. Many go to extraordinary lengths – paying cash for therapy, traveling to distant cities for treatment, self-medicating – all to avoid potential career repercussions. Physician Health Programs exist in every state with impressive 90% success rates, yet many doctors don't know about these resources until they're in crisis.True progress requires fundamental shifts: moving beyond superficial "wellness" initiatives to address genuine mental health conditions, fostering cultures where vulnerability is seen as strength rather than weakness, and creating environments where seeking help doesn't jeopardize careers. The Dr. Lorna Breen Act represents a step forward, named for an emergency physician who died by suicide after working on the pandemic frontlines.Have you noticed signs of struggle in a colleague or friend? Reaching out could save a life. What small step might you take today to create a more supportive environment for those battling silently around you?National Suicide Prevention Lifeline If you enjoyed this episode of the Employee Survival Guide please like us on Facebook, Twitter and LinkedIn. We would really appreciate if you could leave a review of this podcast on your favorite podcast player such as Apple Podcasts. Leaving a review will inform other listeners you found the content on this podcast is important in the area of employment law in the United States. For more information, please contact our employment attorneys at Carey & Associates, P.C. at 203-255-4150, www.capclaw.com.Disclaimer: For educational use only, not intended to be legal advice.

Hey, it's Mark here and welcome to the next edition of the Employee Survival Guide where I tell you, as always, what your employer does definitely not want you to know about and a lot more. Okay, let's unpack this. It might surprise you to learn that surgeons, well, the professionals we really rely on, actually have the highest rate of suicide among physicians. Yeah, it's quite a stark statistic. There was a study back in 2011, I think. That's the one. It highlighted that, get this, 15% reported considering suicide at some point

in their career. 15%. And wasn't it something like 6% just within that past year? Exactly, 6% in one year. When you hear a number like that, it really makes you stop and think about the immense pressures people face. Definitely. Even people who seem incredibly successful on the surface. It's a truly striking paradox, isn't it? These are individuals operating at the absolute peak of a demanding profession. Mm-hmm. Top of their game.

Yet they're grappling with such profound internal struggles. It just begs the question, what is it about this high stakes environment? What is it that contributes to this reality? That's exactly what we're diving into today. We wanna explore the complex factors, the things contributing to these mental health challenges in surgery.

And also look at potential paths toward, you know, support and change, real change. Right, and to really get under the skin of this, we're drawing on some pretty compelling material. We are, we have the presidential address by Dr. Kerry Cunningham, incredibly powerful and personal stuff. Given to the Association for Academic Surgery, right.

And thankfully there's a YouTube transcript available. Yeah, which is great. And we're also weaving in insights from two articles that shed more light on this really serious issue of physician suicide. So consider this your kind of streamline guide. We want you to be well informed on this crucial topic. And our aim is to go beyond just, you know, listing facts. Right.

We want to extract the core insights, understand the complexities underneath, and hopefully identify some actionable takeaways. So where do we start? How do we begin to unravel this? Well, I think Dr. Cunningham's address is a really compelling entry point, just because it's so rooted in her own lived experience.

Absolutely. I mean, here's someone who achieved remarkable success by any conventional standard. Totally. Former top junior tennis player, Harvard professor of surgery. Yeah, with significant research funding and R01 grant. And president of the AAS, a major surgical association. The list is impressive. It really is. And that's precisely what makes her story so, well, resonant. Because alongside all of that success, she bravely shared her own long-term battles.

Yeah, with depression, anxiety, and also a substance use disorder. That juxtaposition, her professional triumphs versus her personal challenges, it really forces us to confront that common misconception, doesn't it? That outward success equals inner well-being. Yeah, absolutely. And what's particularly noteworthy is the sheer courage it took for her to be so open. Oh, for sure.

She was fully aware of the potential risks, the professional repercussions of sharing something so personal on such a public stage. And her motivation for taking that risk, it was incredibly powerful. It really was. It seemed to stem from this profound desire to prevent others, her colleagues,

from experiencing similar suffering. And specifically to reduce suicide, right, inspired by losing her friend, Dr. Christina Rae Berkley. Exactly. That loss clearly had a huge impact. And it's crucial to note, she acknowledged her own privilege even as she spoke. She described herself as, I think, capable, free, white, and with resources. Right. And she explicitly recognized how much harder these struggles must be for others.

For medical students, residents, people without those advantages, facing systemic barriers, that awareness adds real weight to her message. It really does. Now, one of the key points she made, and this feels really important, was the need to move beyond terms like burnout. Or wellness even.

Right, when we're actually talking about serious mental health crises. That's such a vital distinction. She emphasized that okay, burnout can contribute, sure. But it's often not the fundamental issue. And the solutions aren't just more self care. No, she put it very directly, didn't she? Something like, all the Peloton rides in the world

are not gonna make my depression go away. Exactly, and she paints a pretty sobering picture of how these crises can develop. Insidious, progressive. Yeah, creeping up over time until they reach a point where, tragically, the person might not even want help. Or even believe their loved ones would be better off without them.

It's just heartbreaking. It really underscores the gravity and the sources also highlight the concerning prevalence of substance use disorders among physicians. Rates higher than the general population, right? Around one in seven physicians. Yeah. And this is linked, sadly, to that higher suicide rate we see in doctors. And the data she cited from the American College of Surgeons survey.

Wow. Just alarming. 13% of surgeons reported suicidal thoughts in the past year. 13%. And 10% within the two weeks before the survey. Shocking. And what struck me was that these rates were even higher for certain groups. Women, residents, and associate professors, I believe.

Exactly. Those are key demographics, likely reflecting specific pressures within the system. Yeah, and that pervasive fear of seeking help that came up again and again in the sources. This massive obstacle, fear of repercussions, fear of stigma. Leading to really concerning behaviors, like doctors writing their own prescriptions. Or paying cash for therapy, going to other cities for treatment, just to keep it secret. It's this climate of secrecy and fear. It seems so deeply entrenched.

And it's particularly troubling when you think about the training process itself. Oh yeah. Dr. Cunningham mentioned that study showing a third of interns develop clinical depression. A third. And it persists. It doesn't just go away after internship. And with the added trauma many trainees face during COVID-19. There's a real concern those trends could get worse. Absolutely. Medical training is just inherently demanding. Long hours, high stakes.

And often a culture that maybe implicitly values stoicism pushing through. Right. And you combine that with any pre-existing vulnerabilities people bring. Like that statistic she mentioned, 45% of survey respondents had experienced serious trauma before medical training. Forty-five percent. That's nearly half. Yeah. It creates a potential perfect storm for mental health issues. So, OK, let's shift towards solutions. Dr. Cunningham shared some really impactful lessons from her own journey.

She did. And the first one that really hit home was this fundamental principle. Put health first. Yeah, and it wasn't just about your health. It was a call to action for colleagues. So look out for each other. To step up if you think someone's struggling, even if it feels awkward. Right. Checking in, showing up. those simple acts can make a huge difference. She really emphasized that someone's well-being, when they're in crisis, it just outweighs any professional concerns. And she acknowledged how uncomfortable intervening can be.

Yeah. That the person might deny it, get angry, pull away. But her message was clear. If you're genuinely concerned, act anyway. Trust your gut. Another critical lesson was about physician health programs, PHPs. Right. She explained they exist in every state, a vital resource for doctors facing crises, including substance use.

And it was interesting that she admitted she didn't even know about them before her own crisis. Yeah. And she made a strong point challenging the common idea that they're just punitive. Exactly. While patient safety is part of it, their main focus is also advocacy and support for the physician. Helping prevent unnecessary reporting to licensing boards, guiding them to real treatment. And the success rates she mentioned from Washington State were really encouraging.

Over 90% no further board issues, 80% maintaining sobriety. That's huge. It sounds like her own experience with a PHP, though maybe tough at first. She perceived it as punitive initially, yeah. But ultimately it was beneficial for her recovery. And she stressed that sobriety alone wasn't enough. No, addressing the underlying emotional pain was crucial. And she was so open about her own diagnoses. PTSD, persistent depressive disorder, substance abuse disorder.

That openness is just so important for destignation. Her third lesson was, don't assume anything. Right. Everyone has unique experiences, vulnerabilities, hidden values. And that stat again, 45% experiencing trauma before medical training, it really drives that point home, the invisible burdens people carry. It does. And her point about change being constant but growth being a choice? Yeah, requiring patience and hard work. And

also stating clearly, depression is biological. It's an illness, not a character flaw. Such a crucial message. Then her fourth lesson about mastery through mistakes. Ah, yes. Challenging that ingrained culture of perfectionism and surgery. This one really resonated. The idea that you get better by learning from mistakes,

not by trying to be flawless. She talked about how that fear of failure, of losing, can be so destructive. And those internalized bruises from that perfectionist culture. Yeah, they stop people reaching out for help when they most need it. And the emphasis on self-compassion really stood out. Definitely. That we're often kinder to others than ourselves.

And relying on external validation is just not sustainable in the long run. Her fifth lesson linked, recovery and identity. She broadened the definition of addiction. Right, not just substances, but any behavior used to avoid vulnerability. And recovery isn't just stopping the behavior, it's this whole process. Self-reflection, processing trauma, building healthy coping skills, nurturing connections. And consciously separating your professional identity from your personal worth. That's vital in a field like surgery. Where the job can so easily become everything, her point about reconnecting with other parts of life, other values, was powerful.

Then the sixth lesson, authentic connection is everything. This really hit the core of that isolation many struggling physicians feel. Yeah, that loneliness. She mentioned depression as maybe grief for lost connections. And that connection itself is like an antidote to addiction and despair.

It's a stark reminder, isn't it? Caregivers feeling so isolated themselves. And the impact of things like patient death, medical errors, they take a huge toll. Which is why proactive peer support programs are so essential. In our seventh lesson, just listen. Such practical advice for supporting someone. Being present, validating feelings, not jumping in to fix things. Just simple human connection and knowing when to encourage professional help. Her final lesson is really packed a punch too. Feel the pain. Yeah, that numbing emotions also limits joy and love. Turn towards discomfort.

Vulnerability isn't weakness, it's strength and hope. Hope requires action. Goals, plans, flexibility, perseverance, agency, all of that. And exposing shame and fear reduces their power. Progress is slow, but steady. And she finished with a strong call for cultural change and advocacy. We need open, honest conversations to tackle stigma and bias. She pointed out the contradiction. Difficulty accessing your own mental health records, yet pressure to disclose them.

And highlighted the Dr. Lorna Breen Act as a vital step forward. Creating safer environments for seeking help. It was so important learning about Dr. Breen herself. The ER doc who died by suicide after working on the pandemic frontlines. Tragic. And the foundation in her name is doing such crucial advocacy work now. So the consistent thread through all this material is that surgeons face a significantly higher risk

of suicide compared to the general public and even other doctors. The demanding work, sleep deprivation, high pressure perfectionism, it all adds up. But that reluctance to seek help because of stigma and fear of consequences, that remains a critical barrier we have to break down. It really paints a picture of a community committed to healing others,

yet struggling with its own well-being. Dr. Cunningham's story, plus the broader data, just underscores the urgent need for a cultural shift. A fundamental shift around mental health in the profession. Absolutely. Embracing vulnerability as strength, fostering connection as necessity, prioritizing mental health as, well, essential. For the individual surgeon and for the health of the entire profession. Couldn't agree more. So as we wrap up this deep dive, I'm thinking about the broader implications here. Yes, we focused on surgery. But the pressures, the identity struggles, the fear of asking for help.

These themes resonate way beyond medicine, don't they? In many high stakes fields, maybe even in our own lives. For sure. So, a final thought for you listening. What small concrete step could you take today to maybe help foster a more supportive, open environment either for yourself or for those around you? Perhaps exploring resources like physician health programs or checking out the Dr. Lorna Breen Heroes Foundation could be a good place to start learning more.

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